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Both type II (consumer/client-on-worker) and type III (worker-on-worker) workplace violence and mistreatment exist within the sign language interpreting field, however type III (also known as horizontal violence or lateral aggression) is more commonly reported. Between 22 to 90% of sign language interpreters have witnessed and/or experienced forms of horizontal violence or behaviors associated with it and 0 to 8% have knowingly perpetrated horizontal violence against another interpreter. This perspective article aims to provide a cross-industry approach by sharing general practices and previous strategies used within the mental and general healthcare settings. We describe how these tools have been adapted to other industries and model how to apply them to the sign language interpreting field. Available regulatory guidance emphasizes employer responsibility for identifying workplace violence hazards and implementing evidence-informed prevention strategies. Safety and Violence Education (SAVE) was designed for front-line healthcare professionals who are exposed to multiple, well-documented risk factors for workplace violence. The original SAVE curriculum primarily emphasized the perceived predominance of consumer/client-on-worker violence in community mental health settings. Critical steps in adapting SAVE for sign language interpreters involved organizational/administrative exposure control strategies, like cultivating awareness of how organizational culture intersects with emotional and psychological safety and emphasized behavioral/interpersonal approaches by recognizing, preventing, and mitigating worker-on-worker aggression, bullying, and relational-based conflict. The adapted SAVE sought to "break the cycle" of horizontal violence and establish a sustainable culture of safety, respect, and professional resilience among sign language interpreters.

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) provides temporary mechanical circulatory support, primarily for patients with compromised cardiac function. In individuals supported on femoral VA ECMO with concurrent pulmonary dysfunction, poorly oxygenated blood may be ejected from the left ventricle resulting in differential hypoxia to the upper body, or Harlequin syndrome. A retrospective, observational review of our institutional experience in managing patients who developed Harlequin syndrome from March 2016 to May 2021 was conducted. We evaluated interventions to correct Harlequin syndrome, pre-cannulation laboratory values, clinical outcomes, and overall survival to discharged. Forty-four patients developed Harlequin syndrome during the study period. Eleven (25%) patients underwent ECMO revision, while 33 (75%) patients did not. The ECMO revision group had a Survival after Veno-Arterial ECMO (SAVE) score of -15 (interquartile range (IQR) -17, -11), while the non-revision group had a SAVE score of -6.0 (IQR -10, -1). The median time to resolution of Harlequin syndrome for the entire cohort was 4.5 h (IQR 1.4, 7.80). Hospital length of stay was similar between groups. There were eight (73%) patients in the ECMO revision group who survived to decannulation, compared to 23 (70%) patients in the non-revision group. Our findings underscore Harlequin syndrome as a serious complication of femoral VA ECMO. Our observed findings also suggest that physiological interventions can effectively resolve Harlequin syndrome and should be considered as a key strategy before considering ECMO revision. The online version contains supplementary material available at 10.1007/s12055-026-02185-w.

The 3 Abrahamic religions, namely Judaism, Christianity, and Islam, regard the human being as the most noble and perfect being due to their monotheistic attitude and value him above all creatures. This dignity is such that even the human embryo is viewed as a complete and perfect human being. All 3 religions place a high value on unborn life generally and prohibit abortion but allow exceptions when the mother's life is in danger. In Judaism, abortion is permitted to save the mother's life based on the concept of rodef, and some scholars allow it for pregnancies resulting from adultery or potential birth defects. Catholicism uses the principle of "double effect" to justify abortion when necessary to save the mother. Islam prioritizes warding off harm over gaining benefits, permitting abortion only when a certain benefit to the mother outweighs the harm to the fetus. Although there is a controversy over the human embryo in the early days of its formation, all 3 religions agree on the illegitimacy of abortion in the final months of pregnancy. Perhaps the permission of abortion in the event of a risk for the mother's health to preserve her health and well-being is the most important common ground of these 3 heavenly religions. The abortion permission in other cases, such as disability, maiming, is a matter of dispute between the 3 religions.

To develop, clinically implement, and use automated treatment planning for lung cancer radiotherapy (RT) via an in-house treatment planning optimization system, the expedited constrained hierarchical optimization (ECHO). The ECHO system accepts segmented tumor and normal tissue contours and clinical dose/volume criteria as inputs and generates optimized fluence maps for intensity-modulated RT (IMRT) and leaf trajectories for volumetric-modulated arc therapy (VMAT). Dose/volume criteria for our clinically used seven lung cancer fractionation schedules were implemented in ECHO. For each schedule, ECHO internal optimization parameters were tuned using 5-7 previously treated patients and validated with additional 20-25 patients. Since May 2021, a total of 431 lung cancer patients have been treated with ECHO IMRT. Additionally, from April 2023, 93 lung SBRT patients were planned with ECHO VMAT. Treatment plans optimized with ECHO IMRT and VMAT provide more consistent target coverage and similar organ sparing compared with manually optimized plans. The average planning target volume was 390 cm3 (range: 12-3441) for IMRT and 17 cm3 (range: 2.5-56) for VMAT. The average optimization time was 33 min (range: 7-126) for IMRT and 56 min (range: 21-178) for VMAT. On average, ECHO-optimized plans save 1.5 h per plan compared to manual planning. We have implemented an automated system for lung RT treatment planning at our institution for seven fractionation schedules. Our ECHO approach is robust and adapts to changes in clinical criteria without requiring algorithm modifications or retraining. The proposed treatment planning automation framework saves resources and improves treatment plan quality and consistency.

Background/Objectives: The treatment of multidrug-resistant and hypervirulent Klebsiella pneumoniae is one of today's biggest healthcare challenges. The depletion of therapeutic options necessities the application of new methods. One promising approach is to use phage-derived enzymes that target the capsule and make the causative more visible to the immune system. As proteins, these enzymes must be optimised by reducing their size and antigenicity to make them suitable for repeated use. Methods: In this study, the recently isolated and cloned K2B1orf61 K2 capsule-specific depolymerase was analysed structurally, and certain amino acid residues were deleted by cloning. The following amino acid residues were removed from the 80th (D2_N80), 115th (D3_N115), and 200th (D4_N200) N-terminal, and 250 (D5_C250) and 20 (D6_C20) from the C-terminal positions of the wild-type molecule (D1_wt). The resulting derivative molecules were compared with in vitro and in vivo tests. Results: In the presence of wild-type depolymerase, human serum was able to eliminate the target bacterium and save the lives of mice challenged with the bacterium in an originally lethal intraperitoneal model. However, the D5_C250 derivative lost all activity, meaning that the bacteria with the K2 capsule in the serum survived and all the mice died. Derivatives D2_N80, D3_N115, and D6_C20 exhibited prolonged activity in the serum killing assay, effectively eliminating bacteria within 5 h. Similar activity differences were revealed in the intraperitoneal experiment: D5_C250 had no rescue effect; however, D1_wt, D2_N80, D3_N115, D4_200, and D6_20 resulted in survival rates of 100%, 60%, 80%, 100%, and 20%, respectively. Conclusions: Our results demonstrate that molecular trimming is a promising procedure for developing ideal therapeutic depolymerases.

Virtual critical care (VCC) programs provide remote specialist support to community hospitals caring for critically ill patients, yet Canadian evidence regarding their economic impact remains limited. This study aimed to estimate the cost savings associated with a newly implemented VCC program in Eastern Ontario. A retrospective cost-benefit analysis of the first 19 months of a regional VCC program based at a tertiary academic center supporting 13 community hospitals was conducted. All adult patients with an initiated VCC consultation were included. Cost estimates focused on avoided interfacility transfers, transportation costs, and differences in inpatient costs between academic and community hospital settings. Descriptive statistics were used to compare estimated cost savings with program operating costs. Between April 2023 and October 2024, 473 VCC calls representing 312 unique patient encounters were recorded (298 patients included in analysis). Transfers to larger centers were avoided in 179 cases (60%). Avoided land ambulance transfers were estimated to save $61,101 CAD over the study period. Estimated inpatient cost savings associated with avoided transfers ranged from $687,643 CAD (mean length of stay [LOS]) to $2,681,420 CAD (median LOS), corresponding to monthly savings of $36,191-$141,127 CAD. These savings approached or exceeded the estimated VCC program monthly operating cost. The Eastern Ontario VCC program was associated with substantial estimated cost savings, primarily through avoided transfers and reduced use of high-cost academic intensive care beds. These findings support VCC as a potentially cost-effective health system intervention for supporting critically ill patients in community hospitals.

Addressing stigma, mental health, and health care access challenges for people living with HIV requires a multifaceted approach. Generative artificial intelligence (GenAI) chatbots may be one component of this approach. GenAI chatbots can reduce travel costs and save time. They provide opportunities to offer users a discreet alternative to human interaction, helping reduce stigma and improve comfort. They are easy to use, have multilingual capabilities and high levels of user satisfaction. Emerging evidence on GenAI chatbots suggests promising potential for enhancing HIV prevention, such as supporting HIV self-testing and providing information on PrEP, counseling, providing access to information, and role-playing HIV status disclosure. Successful implementation of GenAI for HIV care, however, requires careful consideration of ethical and practical issues to ensure safe and responsible use. Building user AI knowledge, trust, and ensuring ethical integrity will require meaningful collaboration between technologists, clinicians, researchers, and those most affected by HIV.

Peripheral arterial disease (PAD) is one of the most common underlying causes of major lower extremity amputations (LEAs). Often revascularization is not adequate to save the leg. Tibial Transverse Transport (TTT) represents a revolutionary approach to increase angiogenesis in people with critical limb threatening ischemia (CLTI). A systematic review and meta-analysis was conducted across six databases. Inclusion criteria required studies to evaluate TTT combined with revascularization versus revascularization or TTT alone as a monotherapy. Outcomes analyzed included tarsal-metatarsal amputation (TMA), wound healing, and change in visual analogue scale (VAS) for pain. A total of five studies were identified across four databases that met inclusion criteria. TTT + Revascularization was shown to have a protective effect in reducing follow up TMA, O.R = 0.44 [0.23, 0.81], p = 0.009. TTT + Revascularization was also found to have an association with wound healing, OR = 3.25 [1.84,5.73], p = 0.0001. Four studies observed the change in Visual Analogue Scale (VAS), and the cumulative effect showed no association between either TTT + Revascularization or monotherapy with change in VAS pain pre and post procedure, standard mean difference = -0.05 [-0.16, 0.05], p = 0.33. TTT in combination with peripheral endovascular revascularization offers a promising addition for patients with CLTI with lower incidence of TMA increase rates of wound healing. However, considering the limited studies available and overall small sample size, further trials are necessary to understand the relationship between this novel therapy and CLTI management.

We encountered a male infant with extremely low birth weight born at 22 weeks and 0 days of gestational age in the toilet at home. He was resuscitated with chest compression and bag-valve-mask ventilation by the emergency medical service crew and was transported to our institution 50 minutes after birth. The patient was intubated and given intratracheal artificial surfactant after admission. After he recovered from the initial hypotensive phase, we maintained the blood pressure at an appropriate level using nitroglycerin to avoid cerebral overcirculation. He was discharged home at 170 days of life with no signs of intraventricular hemorrhage or periventricular leukomalacia. His overall developmental quotient at one year and seven months of corrected age was 104, and he showed no apparent developmental delay. This case demonstrates that appropriate medical management can save the lives of extremely preterm infants born outside medical institutions.

To compare the reimbursements associated with posterior blepharoptosis, ectropion, entropion, pterygium, and chelation for band keratopathy surgeries performed in an operating room versus an office procedure room and assess the potential benefit of incentivizing the use of the more cost-effective option. Economic analysis. The 2022 Centers for Medicare and Medicaid Services database was used to determine the reimbursement for each procedure when performed in the operating room and office procedure room. Total services for each procedure were aggregated and used to estimate the total cost to the healthcare system based on location.Overhead costs for office procedures were calculated by examining the 3 main costs associated with these office procedures: disposables, human resources, and physical facilities.An incentive analysis was performed, which involved calculations examining the change in annual cost to Medicare if the reimbursement for the study procedures were increased to include overhead costs and various incentive payment percentages. Procedures performed in the operating room cost an average of $2200 more than office procedures. The average overhead cost for office procedures was $150. The total cost of the study procedures in 2022 was $177 million, with >90% of procedures performed in the operating room. Increasing reimbursement by 150% the cost of overhead, when 50% of procedures are performed in the office, saves the healthcare system $52 million. Increasing office reimbursement to cover overhead costs and provide a small incentive to perform procedures in the office could save the healthcare system millions of dollars.

This article examines the impact of artificial intelligence (AI) on cognitive processes and clinical practice, highlighting a delicate balance between benefits and risks. While AI enhances productivity and access to information, it also promotes cognitive offloading and deskilling, the progressive loss of clinical, decision-making, and interpersonal skills, exacerbated by automation bias and reliance. Several studies indicate reduced cognitive activity and autonomous performance when AI is heavily used, despite its proven effectiveness in diagnostic support. They are necessary mitigation strategies to preserve critical thinking and models of human-AI integration to save human clinical judgment. AI should not replace clinicians but support them, keeping core competencies such as critical thinking, empathy, and responsibility at the center.